Provider Demographics
NPI:1174344675
Name:NICKELL, BARBARA JO (MA, TVI)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JO
Last Name:NICKELL
Suffix:
Gender:F
Credentials:MA, TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-5138
Mailing Address - Country:US
Mailing Address - Phone:304-667-5383
Mailing Address - Fax:
Practice Address - Street 1:202 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-5138
Practice Address - Country:US
Practice Address - Phone:304-667-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency